With the slew of downgrades from Fitch, it is important to note that the agency updated its credit rating criteria Jan. 9, 2018, for U.S. nonprofit hospitals and health systems. Under the updated criteria, the credit agency places a heightened emphasis on leverage and liquidity ratios and also considers operating leases and net pension liabilities debt equivalents.

Fitch reviewed 138 credit ratings, or about half of its portfolio of hospitals and health systems, due to the criteria changes. During the review, 25 hospitals (about 9 percent) were downgraded. Fitch does not believe the slew of downgrades is indicative of a wider, downward trend.